Deep vein thrombosis.

Abstract

In this review of deep vein thrombosis including a brief section on postpartum venous thrombosis and the contributory effects of estrogen-containing oral contraceptives new investigatory methods particularly of early disease are discussed. These new methods allow a better correlation of clinical and pathological events which is essential if a rational management approach is to be found. 2 types of deep vein thrombosis are defined i.e. peripheral which in itself is seldom serious and iliofemoral involvement which can be and usually is complicated by acute and chronic morbidity. Lung scanning using iodine-131 macroaggregated albumen routine phlebography and routine iodine-125 fibrinogen scanning are suggested in early diagnosis of pulmonary infarction an important complication of deep vein thrombosis. Ultrasound is a further diagnostic procedure which may become a simple preliminary scanning device to indicate the need for iliofemoral phlebography. Postpartum venous thrombosis is often iliofemoral as is antepartum disease; the latter is more difficult to manage and often ends in pregnancy termination. Studies have established that high-estrogenic oral contraceptives produce a significant increase in venous thromboembolism incidences. From the clinicians viewpoint surgery for those taking an estrogen oral contraceptive presents a greater risk. It is not yet precisely known how the pill increases the risk of venous thrombosis or how soon aften stopping use of the pill the risk is eliminated. Consequently use of the pill is considered inadvisable. Anticoagulant regimes have not been satisfactorily proven effective in the treatment of thromboemobolism. Thrombolytic agents such as urokinase obtained from human urine and streptokinase have proven effective in venous thromboembolism therapy but it remains to be determined to what extent they will replace venous thrombectomy. Surgery seem to be the best method of treating venous thrombosis at present.